Understanding the Unique Challenges & Opportunities of ... · Medical Informatics Officer, Association of Public Health Laboratories . Laura A. Conn, MPH eCR lead, Public Health Informatics

Understanding the Unique Challenges & Opportunities of Combating COVID-19 in LMICs

June 15, 2020

Agenda● Brief introduction to AMIA’s Webinar Series, the role of Global Health Informatics, and

moderators :○ Carl Leitner, PhD, Technical Director, Digita l Square a t PATH Member, AMIA Global Health

Informatics Working Group○ Hamish Fraser, MD, MBChb, MSc, FACMI, Associa te Profes sor of Medical Science, Brown

Center for Biomedical Informatics , Brown Univers ity○ Theresa Cullen, MD, MS, FAMIA, Director of Public Health, Pima County, Arizona, and

Affilia te Scientis t, Regens trief Ins titute● Introduction to the panelis ts :

○ Carol Kamasaka, Divis ion of Health Information Management, Uganda Minis try of Health○ Trad Hatton, MA, MHS, Country Director for PATH in the Democratic Republic of the Congo

(DRC)○ Jacob Odhiambo, The Palladium Group, Deputy Chief of Party, KeHMIS○ Ashish Joshi, PhD MBBS MPH, Senior Associa te Dean of Academic and Student Affairs , and

Profes sor, Population Health Informatics Graduate School of Public Health and Health Policy, City Univers ity of New York

● Audience Q&A

PresentersJohn W. Loonsk, MD, FACMI Adjunct Associate Professor, Johns

Hopkins Bloomberg School of Public Health & Consulting Chief Medical Informatics Officer, Association of Public Health Laboratories

Laura A. Conn, MPH eCR lead, Public Health Informatics Office, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention

Steven R. Lane, MD, MPH, FAAFP Clinical Informatics Director, Privacy, Information Security & Interoperability Sutter Health, Clinical Professor, Family & Community Medicine University of California San Francisco

Catherine Staes, RN, MPH, PhD, FACMI Professor & Director, Nursing Informatics, College of Nursing, University of Utah

4AMIA | COVID-19 Webinar Series | Global Health Informatics

AMIA + PATH’s Digital Square

Health Informatics is the science of how to use data, information, and knowledge to improve human health, including the execution of scientific research, the delivery of health care services, and the

promotion of public health. AMIA is the multi -disciplinary, inter-professional home for 5,400+ health informatics experts.

Digital Square is a partnership of the world’s leading digital health experts from 40+ organizations and countries working together to strengthen digital health systems in emerging economies. We

support co-investment into scalable technology solutions and create the environments in which they can be sustained. Digital Square is led by and housed at PATH, the leader in global health innovation.

Working Groups of AMIA

AMIA

Clinical Research

Translational Bioinformatics

Clinical Informatics

Public Health Informatics

Consumer Informatics

Intensive Care InformaticsKnowledge Discovery and Data

MiningKnowledge Representation and

SemanticsNursing Informatics

Open SourceStudent

PharmacoinformaticsPrimary Care Informatics Public Health Informatics

Regional Informatics ActionVisual Analytics

Natural Language Processing

Biomedical Imaging InformaticsClinical Decision SupportClinical Information SystemsClinical Research InformaticsConsumer and Pervasive Health InformaticsDental InformaticsEducation EvaluationBioinformaticsEthical, Legal and Social IssuesGenomics and Translational Global Health InformaticsPeople and Organizational Issues

AMIA | COVID-19 Webinar Series | Public Health Informatics 5

To highlight how our members and the broader informatics community is addressing this global pandemic we are launching the AMIA COVID-19 Webinar Series.We will look at the pandemic through a health informatics lens and is designed to share informatics responses to the COVID-19 pandemic. Panelists will share their specific domain expertise, including clinical informatics, public health informatics, translational bioinformatics, clinical research informatics, and consumer health informatics. We will also have special emphasis webinars covering topics related to global health, telemedicine, and public policy during the COVID-19 pandemic. These webinars are open to all at no cost.

COVID-19 CHALLENGES AND OPPORTUNITIES

EXPERIENCES FROM UGANDA

UGANDA COVID-19 STATISTICS

Total confirmed cases: 696 Total recoveries: 240Admissions: 456

Total repatriations: 125Self –exit: 33

COVID-19 RESPONSE STRUCTURE

• Disruptions in continuity of other healthcare services “Between January and April 2020, the cases of malaria diagnoses increased by 56%. Health facilities' delivery has decreased by 15%. The number of children receiving Immunisation services (DPT3) dropped by 20%.” ~ Dr. Jane Ruth Aceng, 13th June 2020

• Paucity of infrastructural and human resources

• Social Distancing Vs the socio-ecological- economic environment.Humans are social beings but key to defeating the COVID-19 pandemic is social distancing, confinement, and self-quarantine, public health measures that have been met with resistance

• Infrastructural boost eg increased connectivity of health services delivery points to the national internet backbone

• Strengthening of private-public partnerships for better healthcare delivery

• Leveraging of Information technology to combat covid-19 with sustainability of solutions beyond COVID-19 in mind

ICT, INNOVATIONS AND STRATEGIC INFORMATION PILLAR

ICT AND INNOVATION

DATA MANAGEMENT

DATA ANALYTICS

SUB-COMMITTEES

Interoperable secure digital health solutions adhering to existing legal frameworks

Data access and data quality

Foster data use through provision of timely data analytics

ICT AND INNOVATIONS SUBCOMMITTE

• Ensuring systems alignment with the ehealth policy and other existing legal frameworks

• Systems deployed are speaking to pillar needso Certification guidelines

• Systems integration• Training and capacity building in the approved systems

SYSTEMS UNDER USE FOR COVID RESPONSE

A variety of integrated systems have been deployed. These include;

eiDSR(electronic Integrated Disease Surveillance System based on DHIS2Case Investigation and Points of Entry ManagementGo.DataContact Listing and Follow Ups


Laboratory Information Management SystemsThe various testing laboratories had already approved LIMS that they have integrated with eIDSR for seamless information flow

Results Dispatch System( Both Web and SMS based)Used for disseminating COVID-19 test results


RestrackTracking samples from points of collection to the laboratory

Integrated Alerts SystemPicks alerts from call centers across the country in addition to other alerts approved systems like the USSD based *260# and the android application(Call the Doctor)


Other categories of systems include:• Contact tracing applications( Both based on Bluetooth and

Ultrasound)

• Risk Communication and Community engagement applications(SMS, Web and USSD)

3.71” h

3.2” w

June 2020

Trad HattonCountry Director

PATH-DRC

The Role of Digital Health Tools and Approaches for COVID 19 Response in the Democratic Republic of Congo

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Today, PATH is harnessing the power of digital tools and fostering innovation in communities everywhere to bring good health within reach of more people faster.

Digital Health accelerates health equity.

PATH’s VisionPATH envisions a world where innovationensures that Health is within reach foreveryone.

Digital Health MissionEnsure digital innovations improve health.

Guiding PrinciplesWe will:

oPut the user first.oCollaborate for impact.oFocus on sustainabilityoUphold country ownershipoEvaluate and evolve solutions.

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INCUBATOR OF INNOVATIVE BUSINESS MODELS with non-traditional

stakeholders, including private sector partners.

TRUSTED, TECHNOLOGY-AGNOSTIC STRATEGIC ADVISOR

for countries.

THOUGHT LEADER supporting investment coordination and scale of

digital health global goods.

PROVIDER OF DIGITAL EXCELLENCE for PATH and PATH

partners.

DESIGNER OF COMPLEX SOLUTIONS from global financing mechanisms to

country enterprise architectures.

PATH is uniquely positioned in the global digital health space and in DR Congo

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PATH’s donors in the DRC• Bill and Melinda Gates Foundation

(BMGF)

• United States Agency for International Development (USAID)

• Centers for Disease Control (CDC)

• Resolve to Save Lives (RTSL)

• Global Fund

• Goldsmith Foundation

Selected PATH Projects in DRC• Digital Health in DRC

• Support development of the National Digital Health Strategy in. Operationalization of the National Agency for Clinical Engineering, Information and Health Informatics (ANICiiS)

• Global Health Security Agenda • Establishment of DRC’s first Emergency Operations Center for epidemic

response

• COVID19 Data Architecture and Systems Development for DRC National Response

• COVID19 Investigation and Rapid Response in Kinshasa

Democratic Republic of the CongoProblems/Challenges • Population of 80 million served by a largely broken

health system with under-trained and underpaid health care workers

• Poor infrastructure including road infrastructure, health facility infrastructure, IT infrastructure

• Human resources concentrated in the urban centers with few skilled health care workers in rural areas

Opportunities• Private sector mobile telephone operators are

expanding coverage rapidly in DRC. • Leadership from among President and MoH

leadership for Digital Transformation• Digital solutions are a way to leapfrog structural

issues

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« Congolese Digitalization will be a lever for integration, good governance, economic growth and social progress». (Translation from French)

Son Excellence Felix Antoine Tshisekedi Tshilombo

3 Tools and Approaches

ANICIIS – Digital Health Agency of DRC

Mobile Emergency Operations Center

Digitization of COVID 19 data collection, integration and analysis

Agence Nationale d’IngenierieClinqiue d l’Information et l’Informatique de Sante (ANICiiS)

• MoH established ANICiiS to promote and coordinate the digital health transformation in the DRC aligned with

• ANICiiS coordinates the development, adoption and maintenance of digital technologies and biomedical equipment for the delivery of quality health care services, the management of the health system and the sharing of health information.

• Design and implement digital health programs • Harmonize multiple digital health investments in

country

ANICiiS Support to COVID19 Response

• Coordination and technical support for identification of architecture for COVID19 data management system

• Chat bot named Doctor ANICiiS to provide population with accurate data and information on COVID. Contributes to fight against misinformation.

• ANICiiS COVID19 SMS channel sends prevention messages to all Congolese with cellphone

• ANICiiS COVID19 web page on freebasixhttps://www.stopcoronavirusrdc.info/

https://www.stopcoronavirusrdc.info/

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Mobile Emergency Operations Center in DRC

Combines all digital capacity and makes mobile via 4x4 which can be deployed to outbreak areas for first response.

Mobile Emergency Operation Centers are a transformational tool for epidemic response, particularly in remote rural areas which lackconnectivity and strategic expertise in response such as is the case of COVID, Ebola, measles outbreaks in DRC.

Integrated COVID Data System for DRC

An integrated COVID data system, developed within the national DHIS2 infrastructure, that allows all the different stakeholders involved in the COVID detection and case management to report and access the data relevant for the case follow up. Monitoring teams have access to all the data through dashboards.

Portail publichttps://www.stopcoronavirusrdc.info/

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https://www.stopcoronavirusrdc.info/

Dashboards to be used by Decision Makers

Leveraging Cross Border Digital Health Solution for COVID-19 Res pons e

Steven Wanyee | [email protected]

CB-DHSHigh level architecture

Health Management Information System

KenyaEMR

Medic Mobile

AMPATHMRS

KHIS

Open Concept Lab

Shared Health Record

Health care Workers Registry

Client Registry

Terminology Service


UgandaEMR

Open Concept Lab



Client Registry

Terminology Service

Regional OpenHIE

UGANDA KENYA

CB-DHSRegional Shared Res ources

CBHMIS

Open Concept Lab




Client Registry

Terminology Service

CB-DHSWork flows - Patient regis tration

Patient visits facility. They are first searched in in the EMR which consults the Client registry (ex. EMPI/MedicCR/OpenCR). If new, the patients are added in the client registry

Health Care Worker

Client Registry

Client

Search

Register

conducts

Visits a facility

Registered patient added

CB-DHSWork flows - Patient vis it encounter

Patient encounter details are entered in EMR and saved on the Shared Health Record. During visits, Health care workers are validated through the Health care workers registry

KenyaEMR

UgandaEMR

AMPATHMRS

HCW validated at EMR login

Client data capture

CB-DHSWork flows - Data aggregation

Reporting on lab results. Lab results definition verifies in the terminology service to ensure unambiguous interpretations of the concepts

KHISUgandaHMIS


Open Concept Lab

Terminology Service


Generates Reports

Fetches information

Validates concepts

Submit Reports

The Cross Border Digital Health Solution is part of the USAID funded Cross Border Health Integrated Partnerships Program (CB-HIPP -https://www.fhi360.org/projects/cross-border-health-integrated-partnership-project-cb-hipp) implemented by FHI360. IntelliSOFT Consulting Limited is sub-contracted by FHI360 to develop and implement the Cros s Border Digita l Health Solution (CB-HIPP).

https://www.fhi360.org/projects/cross-border-health-integrated-partnership-project-cb-hipp

SMAART: A Population Health Informatics framework to address COVID-19

Ashish Joshi PhD, MBBS, MPHSenior Associate Dean of Academic and Student Affairs and Professor

City University of New York, Graduate School of Public Health and Health PolicyNew York

[email protected]

Overview

Need for a population health informatics framework

SMAART informatics framework and its applications

Adapting SMAART Informatics framework to address COVID-19

Work in progress

Number of Internet Users globally

4.54 billionPenetration: 59%

Unique Mobile Phone Users globally


Active Social Media Users globally


Copyright © 2017, Ashish Joshi


DataMulti-dimension,

Multi-faceted, Multi-level

(Temporal)When

Spatial(Where)

Attribute(Who, What,

How)

Human Mind Processing Data

INFORMATIONretained

KNOWLEDGE creation

INFORMATIONlost

Impact Decision-MakingInfluence Programs

and Policies

Need for a Human Centered InformaticsAid


Need for Human centered, Data driven, Evidence based, Transformative shifts,

Integrated approaches, and New solutions to enhance population health outcomes and

well-being across diverse settings


U.S.A

BRAZIL

NIGERIAINDIAHAITI EGYPT

Population Health Informatics (PopHI) framework

Collect process and present population health data

(meaningful and contextual relevance)

Inform design, development, implementation and evaluation

of human centered interventions

SMAART: A Human Centered Informatics Platform to support Population Health Interventions globally

Facilitate data driven, evidence based policy

making.Sustainable Multisector Accessible Affordable Reimbursable Tailored

Community based surveillance

Population health dashboards

Consumer health information platforms

Technology enabled internet, or standalone

SMAART Informatics Theoretical framework

Human Centered and Grounded theory approach– Active involvement and understanding of users– Understanding task requirements– Appropriate allocation of function between user and system, – Iteration of design solutions – Multidisciplinary design teams.

Cognitive Fit Theory– Identifies appropriate representation for a given task

performed by users

• Information processing theory – Facilitates presentation of information as a meaningful unit.

Learning behavioral and humanistic theories– Information highly interconnected, relevant to learner,

multiple content formats and feedback given based onresponses


Community based SMAART DIGITAL

HUB

Research enabled Action oriented Policy Interventions driven by Data

Data, Information Knowledge approach

Human Centered approachInformation Processing Theory

Humanistic, Behavioral, Learning and Self-Efficacy theory

Programs, Policies, Interventions

Application of SMAART INFORMATICS framework to enhance population health


How wealth of COVID-19 data can be used by policymakers in evidence-based decision making?

Navigating a path out of this pandemic crisis will require effective integration of data into decision making

(April1 2020 World Economic Forum).

Adapting SMAART Informatics framework to address COVID-19

Data Challenges

Volume of DataScale of Data

Velocity of Data Speed with which data

is generated

Variety of DataDifferent forms of Data

Veracity of DataUncertainty of data

Too Much Information

Difficult to distinguish which information is reliable and helpful

Too much relevant information too

quick

51

? VALUEMEANINGFUL DATA

CONTEXTUAL & CULTUTRAL RELEVANCE

Wearable sensors Increased digital

data

Technology

challenges

Access to technology

Technology skills

Financial barrier

Technical barrier

Privacy and Quality

Lack of awareness

Research enabled Action oriented Policy Interventions driven by Data

• Global Policy informatics platform

• Tracks geospatial spread of COVID-19 outbreak and policy actions globally

• Designed and developed using SMAART informatics framework

©SMAART Rapid Tracker 20206/17/2020 53

©SMAART Rapid Tracker 2020

DATA

POLICY SMAART INFORMATICS

Data driven, Evidence-based solutions into

Practice

SMAART Informatics framework

6/17/2020 54

©SMAART Rapid Tracker 2020

Policy ModuleTRACK Covid-19

Advisories and Policies

Data ModuleTRACK COVID-19 data

Digital Resource Module

Insights Module

Track Spatial Temporal

trends

World

States (India and US)

Country

Compare

Data recorded

COVID-19 Total casesCOVID-19 New cases

COVID-19 Total fatality

COVID-19 New fatality COVID-19 Recovered

cases

Per million

Daily rate of change

7-day average change Select

Rank

FeaturesGeographic coverage

Variables derived

Trends

Advisory/Policy reclassification

Advisories issued

Policies implemented

Repository of evidence based digital COVID-19 resources (e.g. WhatsApp groups, apps, screening tools)

Generate meaningful trends and present findings in an interactive format using maps, charts, graphs

Data Sources Up to date collection of data from publicly reliable available sources of information

6/17/2020©SMAART Rapid Tracker 2020

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SMAART RAPID TRACKER AS A DECISION AID TOOL: GLOBAL VIEW


COUNTRY WIDE

STATE COMPARISONTEST LABS

HELPLINEPOLICIES IMPLEMENTED NEW CASES PER MILLION FOR

VARIOUS STATES

SMAART RAPID TRACKER AS A DECISION AID TOOL: COUNTRY VIEW

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DATA SOURCES DIGITAL RESOURCE MODULE

INSIGHT MODULE

Work in Progress

Challenges• Data updates at different time points• Each country not releasing the same

data at the same time• No consistent classification of advisory

and policy recommendations.• Some of the links to the data sources

not working or broken.

©SMAART Rapid Tracker 2020 60

Opportunities• Modular, flexible, data driven tool

• Develop global policy database to track governmentresponses to COVID-19 pandemic.

• To be a decision aid tool for governments, policymakers, and researchers for informed policy making.

SMAART RAPID TRACKER An opportunity of Virtual Experiential Learning during COVID-19

6/17/2020 ©SMAART Rapid Tracker 2020

115+ students engaged 7 countries

United States

India

Indonesia

Bangladesh

Ireland

United Kingdom

Australia

“Obstruction is Opportunity and Innovation is Struggle”

Ashish Joshi

Email: [email protected]

Webpage: smaartrapidtracker.org

mailto:[email protected]

● Several additional webinars are being planned to highlight members of AMIA and the wider informatics community

● Visit AMIA.org/COVID19

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AMIA | COVID-19 Webinar Series | Public Health Informatics

AMIA | COVID-19 Webinar Series | Global Health Informatics

https://www.amia.org/covid19

Audience Q&A

Understanding the Unique Challenges & Opportunities of ... · Medical Informatics Officer, Association of Public Health Laboratories . Laura A. Conn, MPH eCR lead, Public Health Informatics

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